What are Cartilage Preservation Techniques?
Cartilage preservation techniques can be defined as surgical measures employed to restore deteriorating joint cartilage in order to prevent or delay joint replacement surgery such as knee and hip replacement.
Articular cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own due to a lack of blood supply. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation (arthritis).
Cartilage preservation techniques help to preserve or re-grow existing cartilage, restore normal joint function, and prevent additional surgeries in the future. Arthritis can be delayed or prevented through cartilage preservation techniques.
Indications for Cartilage Preservation Techniques
Cartilage restoration is indicated for patients with cartilage deterioration or damage as a result of:
- Repetitive use of the joint
- Trauma or injury
- Hormonal conditions, such as osteochondritis dissecans (OCD)
- Congenital bone deformities
- Degenerative joint conditions
Preparation for Cartilage Preservation Techniques
Preoperative preparation for cartilage preservation techniques will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before and 2 weeks after surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Cartilage Preservation Techniques
Most cartilage restoration procedures can be performed arthroscopically, a minimally invasive surgery that involves making 2 to 3 small keyhole incisions around the joint using an arthroscope, a small flexible tube with a light and video camera at the end that enables your surgeon to view the inside of the joints and perform surgery. In certain cases, open surgery may be required to access the affected area requiring longer incisions. Your surgeon will discuss the best surgical options for you based on your condition. All procedures are performed under regional or general anesthesia.
Some of the most common procedures for cartilage restoration include:
- Microfracture: Microfracture technique involves poking multiple holes into the subchondral bone below the cartilage with a sharp tool called an awl. This creates a blood supply to reach the damaged cartilage and stimulates the formation of new cartilage.
- Drilling: In this method, a drilling instrument is used to create holes in the injured joint surface. Drilling holes creates a blood supply and stimulates the growth of new cartilage. Although the method is similar to microfracture, it is less precise, and the heat produced during drilling may damage other tissues.
- Abrasion Arthroplasty: This procedure is similar to drilling, but a high-speed metal-like object is used to remove the damaged cartilage instead of drills or wires.
- Osteochondral Autograft Transplantation: This is a procedure in which healthy cartilage tissue is taken from a non-weight bearing part of the bone and placed into the defect area creating a smoother surface on the cartilage of the joint. This procedure is done for smaller defects and can be performed with arthroscopic technique.
- Osteochondral Allograft Transplantation: This procedure is performed when the cartilage defect is large enough for an allograft to be used. An allograft, a block of cartilage or bone obtained from a deceased donor, is used. The allograft is sterilized and prepared so as to fit exactly into the defect area. This procedure does require a larger, open incision.
- Autologous Chondrocyte Implantation: In this method, a piece of healthy cartilage from another site is removed using an arthroscopic technique and is cultured in the laboratory for 3 to 5 weeks to increase their number. Cultured cells form a larger patch which is then implanted into the damaged area by open surgery.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after cartilage preservation techniques will involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anesthetic reactions and monitor your vital signs as you recover.
- You may notice pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- You will be provided with assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities or lifting heavy weights for at least 2 to 3 months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be designed to help strengthen joint muscles and optimize joint function.
- You will be able to return to your normal activities in a month or two; however, return to sports may take 4 to 6 months or longer.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Cartilage preservation techniques are relatively safe procedures; however, as with any surgery, there are risks and complications that could occur, such as:
- Postoperative pain
- Blood clots or deep vein thrombosis (DVT)
- Stiffness of the joint
- Numbness around the incisions
- Injury to vessels, nerves, or healthy cartilage
- Allergic/anesthetic reactions
- Failure of the graft
- Loosening of the graft